Healthcare Provider Details

I. General information

NPI: 1518737675
Provider Name (Legal Business Name): WASILLA CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W PARKS HWY
WASILLA AK
99654-6918
US

IV. Provider business mailing address

101 W PARKS HWY
WASILLA AK
99654-6918
US

V. Phone/Fax

Practice location:
  • Phone: 907-376-4851
  • Fax: 907-373-4851
Mailing address:
  • Phone: 907-376-4851
  • Fax: 907-373-4851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. CRAIG HEDIGER
Title or Position: OWNER
Credential: D.C.
Phone: 907-376-4851